Search results

  1. Merck

    Two Paramedics on a round-the-world trip want to visit other EMS-Systems

    Feel free to PM me if you're coming to Canada (British Columbia). I can probably point you in the right direction. Have fun!
  2. Merck

    32 yr old mom, looking to bounce into the ems field.

    Well I guess I'll respectfully disagree. I think that, given you inability to begin an EMT program before next fall, that an EMR course is a reasonable step. Learning a basic patient assessment model and a systematic approach to patients at a basic level is a good beginning. The 'why' of much...
  3. Merck

    Low dose Ketamine

    This is a nice little video.
  4. Merck

    Ideas for RSI eduction

    +1 for the vent. You can mitigate the need for drugs with a little bit of care for your strategy.
  5. Merck

    Ideas for RSI eduction

    Hiya, I only question the effectiveness of propofol because my admittedly brief research shows the claims are made primarily using animal (murine) models. Not great evidence. My other concern there is that, well, you know how it goes, all of a sudden - "have to use propofol, it's...
  6. Merck

    Ideas for RSI eduction

    Do you guys have AIME education in the states? Might just be Canadian: Anyway, all of our practitioners go through it, one for ALS and one for BLS. Teaches principles, not protocols generally. I'm not associated with them in any way, and have my own critiques of the...
  7. Merck

    Medical helicopter crash in STL

    Well, my opinion (to keep Remi happy, apparently) is that a twin-engine machine is safer. Granted I can't quote great stats and that's for a couple of reasons. The first is that I don't care enough to look - I'm happy to rely on the opinions of people I trust and know are more well-versed in...
  8. Merck


    We use roc so don't have much issue. It was more of an info point on some of the other non-depolarizers. I have no idea what other services use. I'm sure the point is minor.
  9. Merck


    Granted the HD instability is rare, but NMBAs can cause hypotension through histamine release. As well, if a patient has some inherent pull on the vent (i.e. PSV) then paralyzing them could affect their HD status as you transition them to full vent support. (both admittedly minor issues and...
  10. Merck


    Propofol works very well in transport. Perhaps it is a question of experience and training. The notion of not being able to titrate is crazy. As for the idea of paralyzing anyone for transport - no dice. Perhaps I'm not getting the context of the transports as I work in a different system...
  11. Merck

    Nitro Drip for CHF

    There's no issue with it. And 5 mcg/min is only a sniff anyway. The problem with the ER is that they look at the patient as they present and don't appreciate how they were. Guarantee you that if the pt had been pushed in wheelchair into the ER as they presented to you they would have started...
  12. Merck

    Dopamine in septic shock

    Dopamine can work, it is just not usually the best choice. You get, as mentioned, some inotropic and chronotropic effects, but also some squeeze as the dosage increases. However, in general most patients in septic shock are already tachycardic. Given that levo has much less chronotropic...
  13. Merck

    What do you guys think of the decision I made?

    I suppose, knowing little of the EMT-B scope, that from a license/job perspective perhaps you overstepped. I guess it seems a bit odd to me since there is no way a decision like that would even register here. From a patient care/medical perspective, it made zero difference.
  14. Merck

    Interesting Airway Scenario

    That would be an unfortunate protocol. I only say this because I'm generally against any protocol that requires a strict approach to a dynamic situation. VL is great in patients for whom VL is great. But don't underestimate good ole fashioned DL. Visualization is easier with VL in general...
  15. Merck

    Self Defense Instruments

    I carry a little something I call, "Not being a d-bag at work". 100% effective so far....
  16. Merck

    Mechanical Ventilation

    Paralytics are never off the table - they're just part of critical care. But suggesting that everyone should be paralyzed is like saying that everyone with chest pain should get morphine and nitro. In the context of a trauma sure, paralyze for the short term if appropriate. If a patient is...
  17. Merck

    Mechanical Ventilation

    Our program takes an approach of education over protocols. We don't have any written guidelines save for what is found in medical literature. Vent strategies are chosen based on patient presentation, diagnosis, and physiology. Paralysis is certainly not warranted for every patient and we...
  18. Merck

    King County

    Hey guys, Was looking for a bit of info on Medic One in King County, WA. Just a couple of questions mostly for my own interest. If anyone can help can you PM me perhaps? Cheers
  19. Merck

    This makes me mad

    Interesting. I've attended many an overdose and while police are sometimes in attendance it is certainly not a requirement for them to attend, nor have I felt the need. A heroin overdose is not dangerous by definition. Safety is the responsibility of the attending crew first and foremost. If...
  20. Merck


    I think it is likely more than a fad - it's use has been commonplace in ORs for years. The idea of 'I used it and it didn't work' is not evidence. I believe when the number are crunched between CRASH-II and Matters, the NNTT is in the 70s. This seems high, but given that there is little...